Psychotherapy's Greatest Debates - Page 4

Has Mindfulness Been Oversold?

By Ron Siegel and Michael Yapko

Today, mindfulness, once considered an occult Eastern spiritual practice irreconcilable with the secular, Western sensibility of the consulting room, hasn’t simply achieved respectability in our field: it’s everywhere.Sometimes it seems you can’t read a journal or go to a conference that doesn’t have “mindfulness” somewhere in the title. In fact, some believe that the mindfulness movement, if it can be called that, has achieved too much acceptance, too much applause—even acquired a kind of secular sanctity. So there’s something especially refreshing and provocative about the following conversation between a longtime meditator who sees mindfulness as rooted not so much in a spiritual tradition as in an attempt to correct some of the more unfortunate legacies of our evolutionary heritage and a hypnotherapist, skeptical of the gauziness of many explications of mindfulness, who sees it as simply a demonstration of some of the underappreciated healing mechanisms of hypnotic suggestion.

Q: Ron, whatever its spiritual benefits, you seem to think that mindfulness practice has such therapeutic value because it serves as a corrective to so many of our evolutionary survival mechanisms. Please explain what you mean by that.

RON SIEGEL: When we imagine what our ancestors had to deal with in the African savannah, it’s clear that they weren’t all that well-equipped for survival. Their teeth, their claws, their hides, their foot speed didn’t give them much of an evolutionary advantage. Basically, they had two things going for them: a prehensile thumb, with a richly endowed set of nerve endings in their fingers, and good muscles, so that their hands could easily pick up things; they also had their higher cortical processes and capacities for thinking. It was those two advantages that allowed them to survive in competition with the other wildlife.

Today there’s nothing wrong with our thumbs and fingers. They seem to serve us quite well throughout the lifespan, and contribute to our happiness and well-being. But that’s not the case with those higher cortical processes. We’ve evolved to be these creatures who are constantly thinking. What’s worse, we’ve evolved to mostly remember and think about the bad stuff, reviewing it endlessly and imagining how it might happen again. That may be because our happier, more carefree ancestors who tended to live in the moment and didn’t worry about the saber-toothed cats died before having kids. Our more vigilant ancestors were the ones who survived.

Today, across the clinical spectrum, we see people who are utterly tormented by living in the past, having fantasies of endless misery going forward. So mindfulness practice has evolved, in part, to try to gently train the mind to do what it doesn’t do instinctively: to come back to the present, to enjoy the moment, to appreciate the interconnectedness of things, and to not be so focused on survival.

There’s another obstacle to our experience of well-being: we evolved to be concerned with our rank in the troop. Look at any mammal group and you typically see there’s the dominant male with his harem, along with the other guys who want to topple him when they get a chance. That’s how the group is organized. Most of us still spend a remarkable amount of time worrying about how we compare to others, how others see us, and the like. This is another huge source of misery that mindfulness practices try to address by loosening our preoccupation with “me” and our place in the social pecking order. I think that’s why mindfulness practices are so broadly applicable with a lot of different kinds of psychopathology.

Q: At a practical level, how has mindfulness been applied in clinical practice so far?

SIEGEL: There are two broad ways. Effective therapy requires the therapist to be as fully present as possible, not being caught up in the distractions of the day or to-do lists, but being fully available to resonate empathically with the client—which mindfulness teaches. The other way that mindfulness has impacted clinical practice is a basic attitude shift. In many therapeutic traditions, particularly the behavioral traditions, the attitude has been, “Well, we have an unpleasant symptom here: let’s see how we can get rid of it.” But people who try to integrate mindfulness into their work tend to agree with the wisdom of Carl Rogers: “Acceptance is the precondition of change.”

A lot of forms of psychopathology are actually disorders of nonacceptance. When we try not to feel anxious, we become phobic and avoidant, perhaps even agoraphobic. When we try not to feel sad, we shut down and become depressed. When we try not to feel some other dysphoria, we start drinking and have substance problems, and on, and on. Acceptance is often a key factor in resolving most psychological disorders.

Q: More and more therapists seem to be agreeing with that viewpoint these days, but, Michael, you’ve voiced some cautions about the role of mindfulness in clinical practice. What’s not to like?

MICHAEL YAPKO: Well, my background is highly relevant here. I’ve been studying hypnosis and hypnotic phenomenon for the last 35 years. When therapists talk about mindfulness, they tend to offer a spiritual or philosophical explanation of how it works in the therapy room. They often talk as if they’re simply eliciting or awakening something in a person—as if they weren’t a part of that process. But there’s a world of difference between what people say they do versus what they communicate to their clients. When, for example, therapists go through a guided meditation with a client, they don’t realize that they’re being suggestive or are participating in a powerful relationship.

I want to go on record saying that I love mindfulness and experiential learning, which is much more potent than purely intellectual learning. The value of experiential learning over intellectual learning is beyond question. But in applying mindfulness in our work, I think we need to strip away the vague spiritual language in which we discuss it and look at what therapists actually say and do with their clients. When we do, it’s clear that mindfulness methods involve a lot of hypnotic suggestion and hypnotic methods, like age regression, age progression, catalepsy, and dissociation. And it’s the dissociative side of mindfulness, in particular, that impresses me.

Q: Is there something wrong with bringing spirituality into the consulting room?

YAPKO: There’s nothing wrong with it, but, as therapists, we can’t rely on global explanations of what we’re doing and how it works. Clients often know what they want, but they just don’t know how to get it. As clinicians, our job is to articulate the specifics of “Here’s how you get from here to there. Here’s how you move out of global thinking and take specific steps that’ll help you accomplish your goals.” We need to get clear about how what we’re doing can change the concrete realities of somebody’s life.